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Kinnell(1) suggests that the incidence of serial homicide among
doctors may indicate a pathological interest ‘in the power of life and
death’. He notes that other professions may throw up fewer murderers. Our
analysis of serial killers in nursing (2) suggests an alternative
interpretation.
At least in relation to murder of patients, nursing provides further
examples of health care staff who have murdered several patients in their
care. In a review of 34 serial murderers in the USA, six were nurses (3).
We identified 13 convictions of nurses for serial murder of patients up to
1997 (2). In Hickey’s series, nurses had often killed for several years
before being identified (3). Higher risk is associated with the delivery
of intravenous fluids, with being in a bed out of sight of a nursing
station, and with evenings or nights (2).
When this information is combined with Kinnell’s observations on
Shipman and Nesset, it begins to seem plausible that all walks of life
have individuals with the potenital to murder. The key difference may be
opportunity. The features associated with risk noted above suggest that
access and a low chance of observation are important. The difference
between nurses and doctors may be that doctors also control the means of
disposal – in the case of Nesset and Shipman, they also provided the death
certificate. The reason for the difference in number of reported deaths
may simply relate to the doctors’ greater opportunity to remain
undiscovered.
The difference between professions may be less striking than it first
appears. We should not focus on one occupation. It is more important to
develop safe systems. We have argued for the importance of appropriate
critical incident review, which allows the identification of serial murder
as well as other far commoner problems (4). Shipman should not promote
paranoia, but should lead us to consider how best to identify problems.
The techniques for further analysis of unexpected deaths are readily
available, but we should not confine our attention to any one possible
cause -or profession.
Cameron Stark
Consultant in Public Health Medicine
Highland Health Board
Brodie Paterson
Lecturer
Department of Nursing, Stirling University
Brian Kdd
Consultant Psychiatrist
Forth Valley Primary Care NHS Trust
References
1. Kinnnell K. Serial homicide by doctors: Shipman in perspective.
BMJ 2000; 321: 1594-7.
2. Stark C, Paterson B, Henderson T, Kidd B, Godwin M. Counting
the dead. Nursing Times 1997 93; 46: 34 - 37.
3. Hickey, E W. Serial murderers and their victims. Brooks/Cole
Publishing Company: Pacific Grove California, 1991.
4. Stark C, Sloan D. Murder in the NHS: Audit Critical Incidents in
Patients at Risk. BMJ 1994; 308: 477.
I appreciate that the article by Kinnell was essentially a summary
but Michael Swango killed patients in the USA before he came to Zimbabwe.
The problem with him was that information was not passed on to other
hsopitals in the States and also in Zimbabwe. The lesson to be learnt is
that there must be a central database of doctors with known convictions
that can be used by medical councils throughout the world.
Opportunity may be more important than profession
Kinnell(1) suggests that the incidence of serial homicide among
doctors may indicate a pathological interest ‘in the power of life and
death’. He notes that other professions may throw up fewer murderers. Our
analysis of serial killers in nursing (2) suggests an alternative
interpretation.
At least in relation to murder of patients, nursing provides further
examples of health care staff who have murdered several patients in their
care. In a review of 34 serial murderers in the USA, six were nurses (3).
We identified 13 convictions of nurses for serial murder of patients up to
1997 (2). In Hickey’s series, nurses had often killed for several years
before being identified (3). Higher risk is associated with the delivery
of intravenous fluids, with being in a bed out of sight of a nursing
station, and with evenings or nights (2).
When this information is combined with Kinnell’s observations on
Shipman and Nesset, it begins to seem plausible that all walks of life
have individuals with the potenital to murder. The key difference may be
opportunity. The features associated with risk noted above suggest that
access and a low chance of observation are important. The difference
between nurses and doctors may be that doctors also control the means of
disposal – in the case of Nesset and Shipman, they also provided the death
certificate. The reason for the difference in number of reported deaths
may simply relate to the doctors’ greater opportunity to remain
undiscovered.
The difference between professions may be less striking than it first
appears. We should not focus on one occupation. It is more important to
develop safe systems. We have argued for the importance of appropriate
critical incident review, which allows the identification of serial murder
as well as other far commoner problems (4). Shipman should not promote
paranoia, but should lead us to consider how best to identify problems.
The techniques for further analysis of unexpected deaths are readily
available, but we should not confine our attention to any one possible
cause -or profession.
Cameron Stark
Consultant in Public Health Medicine
Highland Health Board
Brodie Paterson
Lecturer
Department of Nursing, Stirling University
Brian Kdd
Consultant Psychiatrist
Forth Valley Primary Care NHS Trust
References
1. Kinnnell K. Serial homicide by doctors: Shipman in perspective.
BMJ 2000; 321: 1594-7.
2. Stark C, Paterson B, Henderson T, Kidd B, Godwin M. Counting
the dead. Nursing Times 1997 93; 46: 34 - 37.
3. Hickey, E W. Serial murderers and their victims. Brooks/Cole
Publishing Company: Pacific Grove California, 1991.
4. Stark C, Sloan D. Murder in the NHS: Audit Critical Incidents in
Patients at Risk. BMJ 1994; 308: 477.
Competing interests: No competing interests